0001209191-21-069389.txt : 20211214 0001209191-21-069389.hdr.sgml : 20211214 20211214133642 ACCESSION NUMBER: 0001209191-21-069389 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211213 FILED AS OF DATE: 20211214 DATE AS OF CHANGE: 20211214 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Yost Mark J. CENTRAL INDEX KEY: 0001740767 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-04714 FILM NUMBER: 211490412 MAIL ADDRESS: STREET 1: C/O CHAMPION ENTERPRISES HOLDINGS LLC STREET 2: 755 W BIG BEAVER RD, #1000 CITY: TROY STATE: MI ZIP: 48084 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Skyline Champion Corp CENTRAL INDEX KEY: 0000090896 STANDARD INDUSTRIAL CLASSIFICATION: MOBILE HOMES [2451] IRS NUMBER: 351038277 STATE OF INCORPORATION: IN FISCAL YEAR END: 0326 BUSINESS ADDRESS: STREET 1: 755 W BIG BEAVER ROAD STREET 2: SUITE 1000 CITY: TROY STATE: MI ZIP: 48084 BUSINESS PHONE: 248 614 8211 MAIL ADDRESS: STREET 1: 755 W BIG BEAVER ROAD STREET 2: SUITE 1000 CITY: TROY STATE: MI ZIP: 48084 FORMER COMPANY: FORMER CONFORMED NAME: SKYLINE CORP DATE OF NAME CHANGE: 19920703 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-12-13 0 0000090896 Skyline Champion Corp SKY 0001740767 Yost Mark J. C/O SKYLINE CHAMPION CORPORATION 755 W. BIG BEAVER RD., SUITE 1000 TROY MI 48084 1 1 0 0 CEO & President Common Stock 2021-12-13 4 G 0 144000 0.00 D 126985 D Common Stock 2021-12-13 4 G 0 144000 0.00 A 144000 I As Investment Manager of a SLAT Common Stock 66466 I As spouse to account holder Represents a bona fide gift of shares as a contribution to an irrevocable Spousal Lifetime Access Trust by Reporting Person, over which Reporting Person retains sole investment authority. The Reporting Person undertakes to provide to the Issuer, any security holder of the Issuer or the staff of the Securities and Exchange Commission, upon request, full information regarding the nature of the bona fide gift and the Trust to which the shares were contributed. Since the date of the last ownership form of the Reporting Person, 66,466 shares have been transferred and are now indirectly held by the Reporting Person in an account in the name of the Reporting Person's spouse. /s/ Caren A. Ries, Attorney-in-Fact 2021-12-14